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Subacromial-subdeltoid (SASD) bursitis refers to inflammation or fluid accumulation within the conjoined subacromial and subdeltoid bursae, which are anatomically continuous and function as a single bursal compartment.

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• It is a common source of shoulder pain and impingement, especially in active or older individuals.

Anatomy

• The SASD bursa lies:

  • Superior to the supraspinatus tendon
  • Inferior to the acromion, coracoacromial ligament, and deltoid muscle

• It facilitates frictionless gliding of the rotator cuff beneath the coracoacromial arch during abduction and rotation.

• It is the largest bursa in the body, typically containing minimal physiologic fluid.

  ![Anatomy of a left human shoulder joint. The subacromial/subdeltoid bursa lays between the rotator cuff, the deltoid, and the acromion. Due to the close location to the rotator cuff tendons, the contribution of the subacromial bursa in the development or healing of tendon pathologies seems obvious. This graphic was created with an image from Servier Medical Art.

  Klatte-Schulz F, Thiele K, Scheibel M, Duda GN, Wildemann B. Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells. 2022; 11(4):663. https://doi.org/10.3390/cells11040663 ](https://prod-files-secure.s3.us-west-2.amazonaws.com/2aa05644-4658-4c26-84d3-64c36b55fb6c/f49001f5-57f8-4779-a8e5-25024f1f8890/cells-11-00663-g001-550.webp)

  Anatomy of a left human shoulder joint. The subacromial/subdeltoid bursa lays between the rotator cuff, the deltoid, and the acromion. Due to the close location to the rotator cuff tendons, the contribution of the subacromial bursa in the development or healing of tendon pathologies seems obvious. This graphic was created with an image from Servier Medical Art.

  Klatte-Schulz F, Thiele K, Scheibel M, Duda GN, Wildemann B. Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells. 2022; 11(4):663. https://doi.org/10.3390/cells11040663

Etiopathogenesis

A. Primary Bursitis

• Overuse and repetitive overhead activity (e.g., athletes, laborers)
• Inflammatory conditions: rheumatoid arthritis, gout, SLE
• Septic bursitis (rare)

B. Secondary Bursitis

• Rotator cuff pathology:
  • Tendinopathy or tears
• Shoulder impingement syndrome:
  • Narrowed subacromial space due to acromial spurs or AC joint osteoarthritis
• Calcific tendinitis
• Trauma or post-surgical changes

Clinical Features